Friday, July 29, 2011

The Morning Drill: July 29, 2011

The International and American Associations for Dental Research have released in its Journal of Dental Research a study that investigated bone fluoride levels in individuals with osteosarcoma, which is a rare, primary malignant bone tumor that is more prevalent in males. Since there has been controversy as to whether there is an association between fluoride and risk for osteosarcoma, the purpose of this study, titled "An Assessment of Bone Fluoride and Osteosarcoma," was to determine if bone fluoride levels were higher in individuals with osteosarcoma.

No significant association between bone fluoride levels and osteosarcoma risk was detected in this case-control study, based on controls with other tumor diagnoses.

In the case-control study, by lead researcher Chester Douglass of Harvard University, patients were identified by physicians in the orthopedic departments from nine hospitals across the U.S. between 1993 and 2000. In this report, the study sample included incident cases of primary osteosarcoma and a control group of patients with newly-diagnosed malignant bone tumors. Specimens of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. The study was approved by the Institutional Review Boards of the respective hospitals, Harvard Medical School and the Medical College of Georgia.

Falling breast cancer death rates have little to do with breast screening but are down to better treatment and health systems, scientists said on Friday, in a study likely to fuel a long-running row over the merits of mammograms.

Researchers analyzed data from three pairs of countries in Europe and found that although breast cancer screening programs had been introduced 10 to 15 years earlier in some areas than in others, declines in death rates were similar.

The findings suggest that "improvements in treatment and in the efficiency of healthcare systems may be more plausible explanations" for falling deaths rates from breast cancer, they wrote in a study in the British Medical Journal.

Epocrates has won over nearly half of the nation’s doctors for its free smartphone apps that lets them look up information on drug dosing, interactions and insurance coverage while seeing a patient.

But like so much else on the Web, “free” comes with a price: doctors must wade through marketing messages on Epocrates that try to sway their choices of which drugs to prescribe.

The apps can select messages based on each doctor’s search and prescription histories, and the company has ambitious plans for expanded smartphone offerings. One possibility is a virtual sales rep that would help drug makers get their wares in front of physicians who decline to see human sales representatives.

The marketing messages are difficult to ignore. For example, a psychiatrist in Massachusetts who recently opened Epocrates (pronounced ee-POC-ra-teez) on his iPhone said that before he could look up any drugs, he had to click past “DocAlert” messages on hypertension, bipolar disorder and migraines. Two of the three showed they had been paid for by pharmaceutical companies promoting their products.

“Some doctors will not have time for that nonsense,” said the psychiatrist, Dr. Daniel J. Carlat, who also writes a blog and newsletter on medical issues.

Of course, any casual user of the Web is bombarded with ads derived from their browsing history.

However, the marketing through Epocrates is more insidious, according to Dr. Adriane Fugh-Berman, an associate professor of medicine at Georgetown University and founder of PharmedOut, a nonprofit group critical of drug companies’ marketing practices.

“With targeted ads in Google, you may buy something that’s an unwise purchase,” she said. “But when a physician is influenced in Epocrates, it’s the patient who’s bearing the financial and health risk.”

Dr. Fugh-Berman and other critics of drug marketing say the apps promote more expensive and sometimes less effective drugs. The companies say they are helping doctors find the best medicines.

Dr. Rachel E. Sherman, associate director of medical policy at the Food and Drug Administration, said the agency was trying to get a handle on all the emerging electronic channels of communication used by drug makers.“It’s a mess,” she said.

Epocrates is betting that the 320,000 physicians who use its apps, much like those who use Google and other advertising-supported data services, will tolerate some marketing to get the information they want at no charge. Epocrates is also used by a million nurses, pharmacists and medical students.

The radical change in how Google aggregates and displays user reviews has many implications and fall out for dentists. One obvious one is “Don’t put all your eggs in one basket.” Or to say it in a more businesslike fashion, diversify.

A strong online footprint should include a web page, social media, search engine utilization, e-mails, review sites and more. That kind of diverse presence not only gives you far more online visibility it protects you if one source falters, like Google Places user reviews.